1. Technical Field of the Invention
The present invention relates to a garment for assisting a person (e.g. a caretaker etc.) in the lifting, positioning or performance of therapeutic interventions of a second individual (e.g. a patient). The present invention relates to a garment (s) worn by the person requiring assistance that assists both the caregiver, and the person who needs assistance. Chance of injury to the caregiver is reduced and improved comfort and physical performance of the person requiring assistance is achieved.
2. Description of the Related Art
Current research shows continued high rates of work related musculoskeletal disorders among nurses and physical and occupational therapy practitioners resulting from handling and moving patients. Obesity indices show increasing numbers of patients who are overweight, and projected shortages of nurses and therapists makes it increasingly important to prevent such injuries. Over time a great variety of lifting and transfer devices have been developed that use a garment that must first be placed on the person requiring assistance. The garment/sling is then connected to a mechanical device that enables the caregiver to safely assist a patient in moving from one position or from one location to another.
Various examples of such garments and mechanical lifting devices that can be used in conjunction with such garments are disclosed for example in the following U.S. Pat. Nos. 3,234,568; 4,050,737; 4,739,526; 4,748,701; 4,981,307; 5,502,851; 5,647,378; 6,122,778; 6,196,229; 6,244,991; 6,276,006; 6,752,776; 6,942,630; 6,890,288; 7,945,975; 7,979,919.
There are four basic categories of mechanical lifts, each designed for a specific care task and each using a different designed sling to lower or raise the patient from one position to another.
The first category is the dependent lift. This lift comes in floor-based models, which are designed to be mobile and move from room to room, and ceiling lifts, which are built into the infrastructure of the ceiling in the facility, with tracking that the motor moves along, to allow lifting of patients from one position to another, to be boosted up in bed, or turned over in bed, or to be lifted from the bed to a chair and back etc. The slings or garments that can be used with these devices fall into four categories. One is a total lift sling that totally lifts the patient up and cradles them; the second is a walking, or ambulation sling. There are a few different types of walking or “ambulation” slings. One kind is a closed vest-type, with straps hooking from the shoulders to the lift. Another kind is a torso garment with straps from the waist to the overhead lift. The third category is turning or boosting slings, which are designed to roll the patient over or boost up or reposition in bed. The last category is limb slings which are basic straps designed to lift a patients' limb while caring for the patient. The caregiver must decide whether the patient is going to be lifted dependently, moved in bed or walk/ambulate, and choose the appropriate sling/garment.
Another type of lift is the powered sit-to-stand lift, which has a different specially designed “belt-type” of sling/garment, with straps that attach from the front of the torso on the sling to the device that raises the patient from sitting to standing. Each manufacturer of a lift has a different design of sling, but the basic concept is the same, with a belt around the waist/torso area, and straps attaching the sling to the lift. Some models of this kind of sling have an extra strap that slides below the buttocks to further assist with the lift.
The next progression towards patient independence is the pull-to-stand lift. This lift has a bar that the patient uses to pull himself up to a standing position. Some versions of this lift come with a “belt-type” sling/garment that hooks onto the lift for patient safety in case the patient leans back, but the patient still pulls himself to a standing position.
When patients are able to do most of the work themselves, the caregiver may choose to use a “gait belt” which is basically a belt around the patients' waist that has built in handles for the caregiver to hold onto in case the patient stumbles or falls. Gait belts come in a variety of designs, from a basic belt to a padded belt with fabric handles at various points.
Even with the wide variety in design and function of each of these lifting and transfer devices and slings/garments, each has its own inadequacies and limitations because each is usually designed for only one purpose. Hospitals and treatment facilities must purchase and keep on hand a great variety of assist garments and choose one when a certain function is performed, and another for a different function, and even then they do not satisfy the many needs that exist. Caregivers are also extremely busy and not having to switch from one garment to another would be a great time saver.
Additionally, for patient rehabilitation physical and occupational therapists have unique needs for handling patients. The goal of rehabilitation pushes the patient to do as much as they can for each mobility task. When a nurse gets a patient up their priority is to get them from bed to chair quickly and easily. When a therapist gets the same patient up, they are more focused on ensuring the patient does as much for themselves as possible with normal movement.
The other unique aspect of therapy is progression from one mobility task to another in succession during one treatment session. When a normal healthy person wants to get up out of bed there are several components or tasks they do to accomplish that. The therapist will break down this function into each task and assess how well the patient performs that task. For example, the therapist first assesses whether the patient can roll over onto their side in bed. If they can, the therapist notes how much assistance is required, then moves on to how the patient gets from lying on their side, to sitting on the edge of the bed, again, noting how the patient moves, and how much assistance is required. Once sitting, the therapist will assess sitting balance, and whether the patient can put their own socks, shoes and pants on, or how much and what kind of assistance they need to do this. They will also assess patients' ability to wash their face, eat, groom etc. From there, they will assess how the patient moves from sitting to standing. Again, technique, normal movement and level of assistance required are documented. Once standing, the therapist will assess patients' ability to walk, assessing how they move their legs, how much help they need, how far they can go, how hard they are breathing etc. All of these activities may be assessed in a single treatment session. Once the therapist has determined where the patient is having difficulties, those activities become the treatment plan to help restore normal movement to those activities and progress the patients' independence. This is one example where the invention provides great assistance.
As the patient changes position, the hand placement for assistance provided by the therapist and the angle of force required to assist the patient changes. In assisting a patient in rolling over in bed the therapist will pull forward on the patients' pelvis and hip area, pulling horizontally towards themselves. Once the patient is lying on their side, to assist the patient to a sitting position, the therapist will grasp under the patients' shoulder and rib cage, and lift upwards and towards the patients' feet, at an angle of approximately 45 degrees. The angle changes as the patient approaches upright, and is then more horizontal as they approach sitting position. This helps bring the patients' torso up to a sitting position. Once sitting, the therapist often needs to prevent the patient from falling. The patient can fall in any direction, so the direction of forces changes for the therapist. In this position, the ideal angle of assistance is directly vertical to hold the patient in a sitting position, although in some situations, for example if the patient has had a stroke, they can “push” to one side or they may have no muscle tone on one side and fall to that side, in which case more support may be needed on one side or the other.
For helping the patient move from sitting to standing normal movement is the goal, so the angle of assistance provided by the therapist changes again. This time the assistance needs to come from the patients' pelvis, upwards and forwards, to assist the patient to a standing position. Once standing, the vertical support would be the preferred angle of support, as again, the patient can fall or stumble in any direction.
Currently there is no one assist garment that can be used to perform several of these functions. Some garments will accomplish two tasks, e.g. a dependent sling can be used to get a patient out of bed and turn a patient over; but there is no garment to assist with the side-lying to sitting portion of the task, and the caregiver/therapist has to switch from one sling to another for each task they wish to assess or work on. Therapists continue to have to manually move or reposition patients resulting in persistent high injury rates to therapist. Therapists also resist using the safety lifts and devices because current slings/garments prohibit “Normal” movement. This is an important component for proper patient rehabilitation. When the therapist has identified the specific area that the patient is having problems, treatment will be aimed at practicing this component of the task over and over so that the patient gets stronger or re-learns how to complete that component of the task, thereby enabling them to become more independent, and require less assistance for performance of the task. The nature of this means therapists are putting themselves in harm's way over and over again, as they are providing the manual assistance to the patient over and over again. Frequently treatment sessions are terminated because of the therapists' fatigue level, rather than the patients' fatigue level. Because of the limitation of available slings/garments, there is often no way around this for the therapist. The result is both risk of injury to the therapist, and risk of not maximizing progress for the patient.
The prior art waist or “gait” belts have limited assistive value. A gait belt is a padded or non-padded belt that fits around the patient's lower rib or waist area and can come with multiple handles that are used to support the patient should they start to fall. Some of the commonly known drawbacks of gait belts include: 1) they can be uncomfortable for the patient, 2) they have a tendency to slide up during transfer, and 3) gait belts will not prevent a patient from falling. They may help stabilize the patient if they just lose their balance momentarily, but for prevention of caregiver injury, their effective use is limited to patients who only need minimal assistance, or “a guiding hand”.
Most of the slings/garments that are available for the sit-to-stand devices do not promote normal motion for a patient coming from sitting to standing. They are designed to “lift” a patient up from sitting so that the patient can be transferred to a chair or back to bed. Most models require the patient to “just lean back” and let the machine bring him up to standing. Some models do encourage more normal movement, but the garment/sling perform only this function. Moreover the slings have a tendency to ride up under the patients' arms. Once the patient is up, the angle of pull of this sling/garment is not ideal for ambulation, and the patient can only ambulate in the device that the sling/garment is designed for. If the therapist wants to progress the patient to a different activity, they must first take this sling off and switch to a different garment.
One other available sling/garment on the market in the field of therapy is the “Lite Gait” sling. This sling is designed to help a patient ambulate on a treadmill. The sling/garment supports some of the patients' body weight thus enabling them to walk more easily. The sling/garment is suspended from an overhead bar on the “Lite Gait” frame. The application of this garment is limited to only this function. The other tasks that have been mentioned earlier are not helped by this sling/garment.
Another similar garment is taught in U.S. Pat. No. 6,302,828. This standard unweighting harness is used for ambulation, however, it will not function for bed mobility tasks and can only be used with a vertical sit-stand assist lift, which is not normal movement, and is not helpful in retraining a patient to perform this task normally. Further products such as Lokomat™ driven gait orthotic that automates locomotion therapy on a treadmill and improves the efficiency of treadmill are known. It is a robotic assistance training tool which uses a harnesses to take weight off of the body. However, once again, these harnesses are designed only for ambulation and not for the other tasks described,
One key feature to note in most of the slings/garments that are available is that the straps that interact with the mechanical devices are fixed onto the garment, in a fixed location with a fixed or limited availability to change the angle of pull. This is a key difference of the described invention that sets it apart from other garments currently available. The invention includes multiple points for attaching and detaching straps that can be moved to apply assistive force in any direction, from any point on the patients' torso and pelvis. For effective rehabilitation and therapy, multiple different pull angles and multiple levels of assistance within these angles are often required by the therapist in one treatment session with the patient. Variability, not only of the angle of pull, but of the level of assistance provided by the lift and strap/garment combination is essential, for a multitude of positions and mobility tasks. Another improvement offered by the invention and not the prior art is the ability to have an elastic component to the straps for varied levels of assistance or support provided to the patient. This enables a therapist to “Make a patient work on a specific task”. In rehabilitation of patients, especially if the patient has suffered damage to the brain where they must re-learn a movement, they must practice a task over and over. When the goal of rehabilitation is to improve the patients' strength, the therapist must progress the patient to increasingly difficult tasks, as the patient accomplishes one level.
An example of this is a patient who needs strengthening for their shoulder. In any therapy clinic, you will see stretchy, elastic bands of varying colors. The therapist will first choose a light resistance to have the patient work against, then as the patient improves; the therapist will make it harder by giving the patient stronger and stronger resistance for them to work against. This is a universally accepted method of patient functional progression for limbs when the patient can do the work themselves.
By comparison, when the weakness is located in the patients' trunk, for example when they are not even strong enough to hold their weight up against gravity, far less added resistance is needed, the same principle is used in reverse, to help them progress. When a patient has little to no trunk strength, the therapist(s) provide “maximal” assistance. This is referred to as “the patient is totally dependent”. The assistance is provided by the physical strength of the therapist. Once the patient progresses a little, the therapist(s) then provides “Moderate” assistance. This means that the therapist does a little less work and the patient does more. The next level is labeled “minimal” assistance. Max assist means that the patient does less than 25% of the work, and the therapist does the rest of the work. Moderate has the patient expending 25-49% of the work and the therapist doing the rest etc. The current art provides no way for a therapist to use equipment and/slings to progress a patient in this manner. The “progression” comes purely from the variable amount of assistance provided by the therapist. In many cases, this results in therapists lifting upwards of two tons per day.
The invention provides an assist garment that permits the use of progressive resistance straps to provide the described progression, thus taking advantage of the theory behind using progressive resistive bands for shoulders. For maximal assistance to the patient, a strap with strong elastic would be used, i.e. little “give” to it. As the patient gets stronger, a strap that has more “give” and more elasticity would be used. Once the patient can tolerate holding themselves up against gravity, the straps could resist the movements by changing the points of attachment and points of pull. For assistance, they would be placed in synergy, or along the intended path of the patient movement; for resistance, they would be opposing the desired movement.
The economic climate in health care means fewer staff is expected to see more patients. Stiff competition for clients has led to the need for efficiency and competitive patient outcomes at the same time. Facilities are benchmarked against each other based on how much better their patients get, in what period of time. There are also increasing financial incentives for facilities to out-perform their competitors. These factors mean that the pressure on therapists and caregivers to get patients better quickly is great. Time is a short commodity in most healthcare facilities. Time and ease of use of safety devices and slings is critical. Current garments and slings are not conducive to progressive patient mobility with minimal extra time for the caregiver. The result is those caregivers do not use safety equipment, instead, putting themselves, and sometimes their patients at risk for injury. The invention helps to achieve these beneficial results.
Certain patents and publications have disclosed concepts associated with assisting handicapped or incapacitated patients, but none meet the needs filled by the present invention. U.S. Pat. No. 6,122,778 issued Sep. 26, 2000 to Cohen describes a loose-fitting vest or garment which enables caregivers to assist a patient in moving from one position to another. Similarly, U.S. Pat. No. 5,647,378 to Farnum discloses a lifting support belt constructed of an elastic, flexible rubber-like material and includes a plurality of flexible handles, which are fixed to the belt in a spaced apart relation. The Farnum design requires the length of the belt be customized to fit different sized individuals. While useful in some situations, the handholds of the Farnum design do not provide adequate leverage to a caregiver in all situations. The Farnum design includes no means for grasping a patient's chest or shoulder area. U.S. Pat. No. 6,244,991 shows a one piece garment having multiple fasteners, 63 and 62 but this garment would be almost impossible to put on an invalid or incapacitated patient because its one piece construction and having both leg and arm holes.